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****** Woman's Health Newsletter *******
November 17, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Mild endometriosis and chances to conceive
2. Stress fractures
3. Reader submitted Q&A-Repeat miscarriage
4. Women and men "feel" strokes differently
5. Health tip to share - Effexor XR(R) continued
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Mild endometriosis and chances to conceive
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The optimal treatment for women with minimal and
mild endometriosis (stages 1 and 2) in order to
improve their chances of conception, is not
totally clear. Many studies have suggested that
neither surgery nor medical treatment really
improves the chances of getting pregnant for early
stage endometriosis. Stage 1 and 2 endometriosis
involves small spots of powder burn-like lesions
(tissue from the uterine lining) located in the
abdominal cavity. These lesions are usually behind
the uterus but do not involve adhesions (scar
tissue) or the ovaries or bowel. Stage 1 has only
a few lesions (typically less than 10) that are
not very deep while stage 2 has more and deeper
lesions but again not involving the ovaries or
bowel or adhesions. Although the criteria surgeons
use are somewhat subjective, it has served as a
useful classification to distinguish different
degrees of endometriosis spread.
The following study from Greece looked at 151
women who were diagnosed with stages 1 and 2
endometriosis and who wanted to become pregnant. A
third were treated with laparoscopic excision and
cautery of the endometriosis, a third were given
medical therapy and a third were given no
treatment at all. The women were then followed for
two years. Pregnancies occurred in 36.7%, 30.5%
and 20.9% respectively. Not all pregnancies
resulted in live births but 30.6%, 25.4% and 16.2%
respectively continued beyond the first trimester
when most miscarriages occur.
Keep in mind that over two years, about 60-80% of
normally fertile women will become pregnant. This
study points out the reduced pregnancy rate with
endometriosis. It also points out that it is
possible to become pregnant even without any
treatment but at a low rate (16%). Endometriosis
is still an enigmatic disease that needs further
research.
Endometriosis stage and ability to conceive
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Stress fractures
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Too much exercise too soon. That's the cause of
tiny stress fractures of the bone. Women are more
prone to them than men, presumably because of less
muscle mass to protect bones from high impact
exercises. Stress fractures occur when the muscles
become tired and the bones of the feet and legs
have to absorb the impact of running or jumping.
Joggers, basketball players, tennis players,
gymnasts and volleyball players are very
susceptible to stress fractures but the most
frequent injuries occur to casual exercisers who
try too much too soon. After the winter season
when individuals decide to rid themselves of
winter fat, physicians start to see foot and leg
pain that ends up being diagnosed as stress
fractures. Even prolonged walking and hiking as
exercise can lead to stress fractures.
MRI may be used to diagnose stress fractures since
they may not always show up on conventional x-
rays. Even if you develop a "plantar fasciitis"
from walking, you may want to have an MRI to make
sure the persistent pain is not from a stress
fracture.
Treatment of a stress fracture is merely to avoid
the activity that caused the fracture. The bone
does not need to be splinted or cast. It just
needs to avoid any repetitive trauma. Stress
fractures can heal on their own if given time.
Additional treatment includes:
Ice the area to reduce swelling and pain.
Elevate the area to relieve symptoms.
Control pain with acetaminophen (Tylenol(R),
others) or ibuprofen (Advil(R), Motrin(R)).
See your doctor if pain lasts longer than 2-3 days
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Repeated miscarriage
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"What sorts of things can cause a woman to
spontaneously miscarry a fetus only a few weeks
after conception?"
"I'm 38 and the few times in my life I have
managed to conceive, I lose the fetus right away,
with 2 weeks of the positive home pregnancy test
(or within 3-4 weeks after conception)- too fast
for me to even get into to see a doctor. I and my
partner (of three years) were treated for a
mycoplasma infection found 2 years ago, but my doc
could not find anything else wrong. Hormone test:
progesterone & testosterone levels are higher than
average but still barely within normal limits.
Estrogen was within normal limits but the ratio of
estrogen to the other hormones was low. (I've been
experiencing perimenopausal symptoms for 2 years).
This miscarriage problem dates back to when I was
only 16 and has occurred at least three or four
times over the last 22 years; I've never been able
to carry longer than those few weeks. I'm still
childless and running out of time." - LSB
Miscarriages are more common than most people
think. It is estimated that 1 million of the 6
million pregnancies each year in the U.S. end up
as a miscarriage. For any one pregnancy, a woman
has about a 1 in 7 chance of miscarrying. As many
as 5% of couples have 2 miscarriages in a row and
about 1% of couples have 3 miscarriages in a row.
This situation is often labeled as habitual
abortion although a better term is recurrent
pregnancy loss (RPL).
Frequent miscarriages are of great concern to many
women even though statistically a woman who has 3
miscarriages in a row still has a 50-70% chance of
conceiving and carrying a normal pregnancy the
next time she becomes pregnant. I find that the
biggest problem is the discouragement that women
have. Often they are unwilling to try again
faced with the prospect that there can be up to a
50% chance they would miscarry. When this problem
occurs, couples are very susceptible to any
diagnosis and treatment suggestions that doctors
offer - perhaps sometimes too much so.
There are some conditions that seem to predispose
to recurrent loss. After 3 miscarriages, the
typical diagnostic studies and procedures that are
recommended are:
Laboratory Tests
thyroid stimulating hormone (TSH)- to detect hyper
or hypothyroidism
serum progesterone (day 21-22 of cycle) - to
detect adequate corpus luteum function
parental (both) blood chromosome analysis - to
determine if there might be a hereditary genetic
cause
lupus anticoagulant - to detect antiphospholipid
syndrome
anticardiolipin antibodies - to detect
antiphospholipid syndrome
Procedures
hysterosalpingogram or hysteroscopy - to detect
anomalous shapes of the uterus
pelvic ultrasound - to detect fibroids of the
uterus
It sounds as if your doctor has concentrated on
possible hormone abnormalities although those have
not really been shown to be a cause of recurrent
pregnancy loss. You might try a second opinion
from another gynecologist or a reproductive
endocrinologist and discuss if you need some of
the above studies. You are now old enough that age
plays a role that it may not have when you were
younger.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Women and men "feel" strokes differently
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Common symptoms of a stroke include difficulty
speaking, facial muscle paralysis or weakness,
dizziness and areas of numbness over the arms,
legs or body. Many women, however, do not always
present with these classic symptoms but rather
they describe atypical stroke symptoms such as
pain in the arms and legs, disorientation and
changes in consciousness. Almost 30% of the time
women have stroke symptoms not usually described
as typical signs.
Part of the difference may be that women
experience more bleeding (hemorrhagic) strokes
while men experience more occlusion of the blood
vessels (thrombotic strokes) in the brain. This
difference, however, does not totally explain why
many women have different stroke symptoms than
men. Some investigators think that the symptoms
are the same but women just describe them
differently than men. (That may be true but my
wife believes it is because women use both sides
of their brain to think and describe while men
mostly use only one side! From my point of
thinking, she may be half right.)
Women also suffer more strokes than men (62% of
stroke deaths) but investigators point out most of
the difference is due to living longer than men,
since strokes increase in frequency with age. Non
neurological signs also described more often by
women having strokes, are chest pain and shortness
of breath.
The bottom line is that women should be aware of
this variation in symptoms and seek out diagnosis
if there are acute episodes of arm or leg pain,
disorientation, loss of consciousness (fainting)
or chest pain and shortness of breath.
Women and men feel strokes differently
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - EffexorXR (R) continued
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Just wanted to tell the lady who is on Effexor XR
for night sweats that I had to stop taking it (at
the same dose, 75 mg, which she stated is a small
dose and it is actually a very common dose)
because it increased my appetite greatly and I
gained 12 pounds in 2 1/2 months. It also made me
lethargic. Be careful driving on it!" - Suzy
[editor note - This just reminds us that health
tips or any suggested medical therapies do not
always work the same for everyone. Be cautious
with medications but at the same time don't reject
a recommended alternative treatment just because
it did not work out for someone you know.]
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Games For When We Are Older..... "
Remember the games you used to play at birthday
parties when you were young? Capture your youth
again at your next birthday with these matured-
with-age games:
1. Sag, You're it.
2. Pin the toupee on the bald guy.
3. 20 questions shouted into your good ear.
4. Kick the bucket.
5. Red Rover, Red Rover, the nurse says Bend Over.
6. Doc Goose.
7. Simon says something incoherent.
8. Hide and go pee.
9. Spin the bottle of Mylanta.
10. Musical recliners.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Health Newsletter *******
December 1, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Alternative arthritis treatments
2. Growth hormone for older women
3. Reader submitted Q&A - Aortic aneurysm
4. Beta blocker meds help the heart
5. Health tip to share - Cranberry juice for odor
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Alternative arthritis treatments
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Arthritis sufferers are well known to be willing
to try almost any alternative medical treatment in
order to obtain relief from the almost constant
joint pain. Many alternative treatments are
advertised as "natural". You must remember,
however, that natural does not always equate to
"safe". Some treatments may have scientific
evidence suggesting they may help while most are
unproven and some are even dangerous because of
side effects or impurities in manufacturing.
Herbal treatments such as evening primrose oil and
capsicum for rheumatoid arthritis and ginger as a
treatment for osteoarthritis may have some
benefits. Most other herbs have not been shown to
be beneficial. One example is a Chinese medicine,
Tripterygium wilfordii Hook F (TwHF) to treat
inflammation and musculoskeletal injuries but it
it becomes toxic at high doses.
Certain nutritional supplements have received
attention and may be beneficial for arthritis. The
best data exists for glucosamine use with
osteoarthritis. Chondroitin sulfate may have
similar benefits also although the data is not as
clear. Vitamins C, D and E have shown some promise
in osteoarthritis although too much vitamin A may
worsen it. S-adenosyl-methionine (SAM-e) is
another supplement that has been used and it may
help with the pain of arthritis. More trials need
to be conducted but there is promise for SAM-e.
Metals have also been used. Copper bracelets are
ineffective but harmless whereas gold injections
may have a positive benefit but side effects can
be significant. Magnets have also been used but
there is little good data to support their use.
Many other modalities have been used to combat the
pain and inflammation of arthritis such as
relaxation techniques, acupuncture, aroma therapy
and others. All have had mixed results. Sometimes
food allergies may be linked with arthritis but
dietary changes should only be based on food
allergy testing otherwise it is almost impossible
to tell what foods to eliminate.
The urge to try additional treatments for
arthritis is real, but try to use some judgment
before investing heavily in time and money to self
test these alternative treatments.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Growth hormone for older women
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Some think growth hormone is the fountain of
youth. There is evidence that it increases muscle
mass in older adults just like your body did when
you were a teenager. Growth hormone has to be
given by injection and it is terribly expensive so
it is not likely to be used on a large scale basis
at the current time. Unscrupulous entrepreneurs
have taken advantage of the theoretical benefits
of growth hormone by offering derivatives,
chemical precursors and even animal growth hormone
sources to entice money from those who want to
stay young forever. These products do not work!
As investigators have begun to study the potential
of growth hormone, one of the questions that needs
to be answered is what are the interactive effects
of growth hormone (GH) and sex steroids such as
estrogen in women or testosterone in men. We need
to know if the sex steroids have any influence on
muscle strength and endurance. The following U.S.
study of community dwelling men and women lasted
26 weeks. They gave growth hormone and placebo as
well as sex hormones and placebo to 57 women and
74 men testing all combinations.
Women increased their lean body mass by about:
0.8 lb on placebo
2.5 lbs with hormone replacement therapy (HRT) alone
2.2 lbs with growth hormone alone
4.6 lbs with growth hormone plus HRT
Men had similar changes.
All of this weight was muscle mass and not fat.
There were some side effects. Women had no
significant change in their strength or
cardiovascular endurance. They also had a problem
with edema when taking growth hormone alone or
growth hormone plus HRT. Men had problems with
diabetes and glucose intolerance as well as joint
pains.
While there may be some medical benefits from
growth hormone, it does not appear to be a
fountain of youth and there are side effects from
the treatment. Hopefully further studies will
clarify when it should be used (eg. muscle wasting
in the elderly).
Growth hormone for older women
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Aortic aneurysm
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"A year ago, I had a lower abdominal scan due to a
mass in my left side. This turned out to be an
ovarian cyst. However, I saw the report, and it
indicated evidence of an aortal aneurysm and a
spot on my liver. I have a history of melanoma.
There has been no mention of the aneurysm or liver
abnormality by either my family doctor or surgeon.
Is this something that should be checked further?
Should my doctor have told me of this?" - J.H.
I think your doctor should have mentioned these
findings to you and made a plan for continued
evaluation. I'll bet it either was an oversight or
the aneurysm was very small and the doctor did not
want to "worry" you about it because most
aneurysms do not get large and rupture. However
there is a trend now to do screening ultrasounds
and if the aneurysm gets bigger, then surgery is
recommended. Such surgery is very major so it
should not be undertaken lightly.
In one screening study, aneurysm was defined as a
maximum aortic diameter of 3 cm or more. Annual
re-scanning took place if the diameter was 3 - 4.4
cm, and at three-monthly intervals if it was 4.5 -
5.9 cm. This protocol was continued until patients
either died or underwent surgery or declined
further follow-up. Aortic diameters of 6 cm or
more, and an increase of diameter of 1 cm or more
in a year, or developments of symptoms
attributable to the aneurysm all constituted
criteria for considering surgery.
The main symptom from an abdominal aortic aneurysm
is back pain. It is not worsened by movement but
is present most of the time. It is a mid back pain
rather than the common low back pain with movement
that many people have. A pulsating feeling in the
abdomen and abdominal pain are other symptoms that
people have. Because aneurysms are often caused by
atherosclerosis, there is a higher frequency in
men than women but women get them too.
Until the recent improvement in imaging
technology, most aneurysms were only discovered on
plain x-rays if they were very big and calcified.
Now, imaging technology has improved and we are
realizing that aneurysms are more common. I think
that you should be followed for this and I would
suggest asking your doctor to be referred to a
vascular surgeon for an opinion as to whether
anything should be done right now. It is hard to
tell from what you describe whether this is an
incidental finding or something that is
potentially serious but I would consider it
serious until a vascular surgeon evaluates you and
the ultrasound findings.
The liver abnormality is probably not related to
the aneurysm but with a history of melanoma, that
also should be evaluated by your oncologist just
to make sure. Now that you have seen the report
ask the doctor about it. I'm sure that since a
year has passed they will want another scan to see
if either finding has changed in size.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Beta blocker meds help the heart
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
After a heart attack, arrhythmia, abnormal heart
rate rhythms may develop along with weakness of
the heart muscle. One medicine commonly used
after heart attacks is called a "beta blocker".
Inderal (propanolol) is the most common but others
like Atenolol, Labetolol and Toprol XL are
frequently used. These meds block the stimulating
effect of epinephrine on the heart.
A recent study shows that patients who were
continued on the beta-blockers even long after
their heart attack occurred still have a lower
death rate. It was 16 % lower after two years and
34% lower after 5 years compared to people who did
not get continued on them.
If you or a relative have had a history of a heart
attack or major heart arrhythmia, be sure to
discuss with the doctor about continuing to take a
beta blocker. Patients who have high blood
pressure are often continued on beta blockers but
if there is no hypertension, sometimes the
medication is just forgotten.
Beta blocker meds help the heart
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Cranberry juice for vaginal odor
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Cranberry juice, everyday, helps with my vaginal
odor. I am diabetic and suffer from vaginal odor,
even if I am not experiencing a yeast infection. I
understand that vaginal odor can also be caused by
liver and kidney function, so the cranberry juice
makes sense. I have also heard that some herbal
remedies intended for liver and kidney function
improve vaginal odor." - I.N,
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Shingles"
A man walked into a doctor's office and the
receptionist asked him what he had. He replied,
"I got shingles."
She said, "Fill out this form and supply your
name, address, medical insurance number. When
you're done, please take a seat."
Fifteen minutes later a nurse's aide came out and
asked him what he had. He said, "I got shingles."
So she took down his height, weight, and blood
pressure, then said, "Change into this gown and
wait in the examining room."
A half hour later the doctor came in and asked him
what he had. He said, "Shingles."
The doctor gave him a full examination, and then
said, "Well, I just checked you out thoroughly,
and I can't find shingles anywhere."
The man replied, "That's because they're outside
in the truck. Where do you want them?"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Health Newsletter *******
December 15, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Diagnosing Alzheimer's disease
2. Nut and peanut butter consumption and diabetes
3. Reader submitted Q&A - SSRI side effects
4. Chronic pelvic pain from a bladder source
5. Health tip to share - Ear pain after flying
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Diagnosing Alzheimer's disease
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There is no easy way to diagnose Alzheimer's
disease short of performing a brain biopsy and
looking at nerve tissue under the microscope. So
if you suspect one of your loved ones may be
developing Alzheimer's disease (AD), what do you
do?
Doctors basically use three different modalities
to make the diagnosis:
interview of the patient and family to learn how
any symptoms have developed over time
physical exam and laboratory testing to rule out
other causes of forgetfulness or dementia such as
drugs, heart failure, diabetes, stroke, brain
tumor, anemia, thyroid disease, Parkinson's
disease
testing with mental awareness tests and imaging
studies such as MRI or PET scans to add weight to
the diagnosis of AD
There is no one test that can say whether AD is
present. Also it is difficult by any means to
diagnose early disease at a time when there is
only mild cognitive impairment. This mild
cognitive impairment is a condition in which a
person still has good judgment and decision
making skills but has more recent memory loss than
would be normal for one's age. It is a stage of
"sharp mind but shaky memory". A person would have
the most trouble remembering recent conversations
and appointments, while recall of long ago events
remains intact.
Mild cognitive impairment does not always progress
to Alzheimer's, but 50% of the time it does. Early
symptoms can include loss of smell particularly
with the lack of awareness of this smell deficit,
loss of emotional reaction to forgetfulness (most
people feel bad about forgetting appointments or
recent information given to them), and inability
to carry on a thought-provoking conversation. You
can only use these as clues; mental assessment
tests administered by psychiatrists, psychologists
or geriatric specialists are much more diagnostic.
If you suspect a loved one may have some
impairment, seek a physician's help.
Diagnosing Alzheimer’s disease
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Nut and peanut butter consumption and diabetes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Nutritional studies that are based on dietary
histories taken from men and women always engender
some suspicion when investigators announce that a
certain food may be associated with a higher or
lower incidence of a given disease. The problem is
that people make many different choices in their
lives that may influence a given disease just as
they make food choices. In spite of the bias
inherent in dietary studies, they often are the
best measure to indicate possible new food/disease
relationships that we have not been aware of
before.
Unsaturated fat (polyunsaturated and mono
unsaturated) are thought to improve glucose and
insulin balance in the body. thus they may have a
role in preventing diabetes. Nuts are high in
unsaturated fats and other nutrients that affect
sugar metabolism. A recent study in the Journal of
the American Medical Association looked at whether
increased nut and peanut butter consumption played
any role in the future development of adult onset
of diabetes.
The study referenced below analyzed data from the
large Nurses Health Study and looked at over
83,000 women aged 34 to 59 years who had no
history of diabetes, cardiovascular disease, or
cancer prior to entry into the study in 1980. They
were followed on the average of 16 years and
completed dietary history questionnaires at the
start of the study. They corrected the data for
patient weight (BMI), physical activity and
alcohol and tobacco use.
The authors found that women who indicated that
they ate nuts 5 or more times a week had a 23%
lower incidence of developing diabetes. Women who
ate peanut butter 5 or more times a week had a 21%
lower incidence of diabetes. Both of these were
compared to women who almost never ate nuts or
peanut butter. The authors did further adjustment
for intakes of dietary fats and cereal fiber but
it did not appreciably change the results.
If you just add nuts to your diet without
decreasing other calories, that would likely cause
diabetes. Therefore the authors caution To avoid
increasing caloric intake but "regular nut
consumption can be recommended as a replacement
for consumption of refined grain products or red
or processed meats."
Nut and peanut butter consumption and diabetes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - SSRI side effects
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I read with interest the recent health tip
related to Effexor(R). I would be interested in
comments on side effects of SSRIs. I had very bad
reactions to both Paxil(R) and Zoloft(R) and I've
done fine on Effexor(R). In fact, it works as an
appetite suppressant, the opposite of what a
reader said in a recent newsletter."
"My question is: What do we know about side
effects and these drugs? Why do you find side
effects listed as "lethargy or insomnia", "weight
gain or loss"? Do we know what's going on?" - Judy
Great question. I'm not sure I can adequately
answer it but let me give it a try. The selective
serotonin reuptake inhibitors (SSRIs) include
Paxil(R), Zoloft(R), Prozac(R), Celexa(R) and a
few others. Effexor(R) has a mixed mechanism of
action, so is not officially an SSRI but it is
used for similar indications.
The SSRIs as a class of drugs were thought to have
minimal side effects compared to other
prescription medications used for depression and
disorders such as panic attacks, generalized
anxiety and phobias. They have been used over the
past decade and the side effect profile is still
favorable but some people have reactions
nonetheless. The commonly described side effects
are nausea, diarrhea, headache, agitation and
insomnia. Loss of sexual desire and sexual
dysfunction are also frequently cited.
I think you can see how insomnia can lead to
fatigue and lethargy. If loss of sexual desire is
part of depressive symptoms, you can also imagine
that if the depression is made better, a person
might claim improvement in sexual desire while
another person who did not have loss of libido
might develop that as a side effect from the SSRI.
Weight loss and weight gain might be considered
opposite side effects and you would wonder how one
drug could produce these opposite effects. To
answer that you would have to answer the question
why some people with excessive nervousness eat and
gain weight while others lose weight due to that
same degree of anxiety. Many drugs can cause both
diarrhea and constipation and we don't really know
why.
The truth is that we know very little about how
side effects are produced by these medicines.
Sometimes a side effect is just a coincidental
change in symptoms or the result of some other
medication or environmental cause and it is
misinterpreted as being due to the primary
medicine. We know from studies of active drug
versus placebo that there still can be a high
incidence of nausea, headache, fatigue etc. in the
placebo group. This must mean these are just
coincidental symptoms but since they happen also
in the active drug group, they become listed as
side effects.
When any one person says that they developed
symptom "X" from taking a new medicine, they can
be right or wrong about the medicine as the cause.
Thus with new medicines, doctors do not know what
are the common side effects until they have had
many patients on that drug and enough return
visits to be able to gauge what the most common
adverse reactions are.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Chronic pelvic pain from a bladder source
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Chronic pelvic pain is very often attributed to
conditions of the pelvic reproductive organs such
as the uterus, tubes or ovaries. Sometimes,
however, the pain may be arising from the bladder
which is also located in the pelvis. Bladder
infections usually produce urinary frequency along
with painful voiding. However, urinary tract
infections are episodic; they do not tend to
produce a constant, chronic pain. The main bladder
condition that causes a chronic pain is one called
interstitial cystitis.
Interstitial cystitis is characterized by an
inflammatory response in the bladder wall but
bacterial cultures are negative. Antibiotics do
not help the pain and urinary frequency. End stage
interstitial cystitis (IC) often results in ulcers
in the bladder wall that can be seen when a scope
(cystoscopy) is used to view the inside of the
bladder. The skin lining the bladder wall is
usually waterproof. In other words the waste
products and salts in urine never touch the nerve
endings and blood vessels in the layer under the
bladder skin (epithelium). Ulcers allow direct
contact to this layer and produce pain and often
urinary frequency.
Concepts about IC are changing, however. It used
to be thought you did not get bladder pain until
there was an ulcer present. Now it is felt that in
early disease there may be small holes, leaking in
the bladder skin, that allow urine salts to get to
the nerve endings and cause pain for years before
there are actual ulcers. A test has been developed
to see if this leaky epithelium is present. It is
called a potassium sensitivity test.
In this test, a mild potassium salt solution is
instilled into the bladder by a catheter. If it
produces a severe pain compared to instilling just
sterile water, then the test is considered
positive. Patients who have a positive test often
respond (about 60% of the time) to a medicine used
to treat interstitial cystitis called pentosan
polysulfate (Elmiron(R)). This is significant
because up until now, we have not had any good
medicines that permanently treat pelvic pain.
With this concept in mind, i.e., that maybe many
instances of chronic pelvic pain really represent
an early bladder skin dysfunction (IC),
investigators set out to test if women with
chronic pelvic pain who were not diagnosed as
having chronic bladder problems, might have
positive potassium (K+Cl) sensitivity tests. They
found that in 244 women with pelvic pain, 81% had
a positive potassium sensitivity test. None of the
47 control patients had a positive test. This
would indicate that possibly these women may have
an early interstitial cystitis and may benefit
from therapy for it.
Chronic pelvic pain from a bladder source
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Ear pain after flying
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Individuals who fly when they have a cold or sinus
congestion risk blockage of the Eustachian tube
that can result in ear pain, infection, hearing
loss, ear ringing and dizziness. To help prevent
this, use a decongestant nasal spray such as
oxymetazoline (Afrin(R), Dristan(R)) or
medications containing pseudoephedrine
(Actifed(R), Sudafed(R)) an hour before takeoff
and an hour before landing. This can help prevent
blockage that leads to ear pain or damage. - FRJ
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Painful Side"
At Sunday School they were teaching how G~d
created everything, including human beings.
Little Johnny, a child in the Kindergarten class,
seemed especially interested when they told him
how Eve was created out of one of Adam's ribs.
Later in the week his mother noticed him lying
down as though he were ill, and asked, "Johnny
what is the matter?"
Little Johnny responded, "I have a pain in my
side. I think I'm going to have a wife."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Health Newsletter *******
December 29, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Antidepressant use and pregnancy
2. Alzheimer's disease and vitamin B3 - niacin
3. Reader submitted Q&A - Serzone(R) warning
4. Gingivitis
5. Health tip to share
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Antidepressant use and pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The newest class of antidepressant drugs called
selective serotonin reuptake inhibitors (SSRIs-
Paxil(R), Prozac(R), Zoloft(R)) are so widely used
now for treating depression and other anxiety-
related disorders that concern has been raised
about their possible effects in pregnancy. It used
to be that pregnant mothers were advised to stop
almost all medications during pregnancy but as
information evolves that certain drugs seem to be
safe, it becomes common to see mothers on more and
more prescription medicines while they are
pregnant.
SSRIs have been shown in other studies not to
produce birth defects or developmental
abnormalities and not to produce behavioral
changes in newborns. Therefore doctors have
allowed women to stay on these medicines when they
become pregnant.
The study below in the American Journal of
Psychiatry looked at a group of women using SSRIs
who became pregnant and found that although there
was no increase in birth defects, the babies were
born about a week earlier (prematurely) than were
babies whose mothers did not take SSRIs.
A week premature (on the average) does not seem
like much of a difference but it can sometimes be
a key difference in survival. This is the first
report that I know of that implies there may be an
adverse effect of SSRIs in pregnancy.
Antidepressant use and pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Alzheimer's disease and vitamin B3 - niacin
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Alzheimer's disease affects almost half of all
individuals over the age of 85. As we adopt
healthier lifestyles in an attempt to prolong our
lives, Alzheimer's becomes more of a concern since
it is almost an epidemic at the age we wish to
attain.
I do not know of any medicine that cures
Alzheimer's once an individual has it so the main
strategy we look for is how to prevent it in the
first place. At the present time the only agent
associated with prevention of Alzheimer's is
estrogen replacement therapy after menopause. With
many women avoiding estrogens due to fear of a
small but real increase in breast cancer with long
term estrogen use, we must continue searching for
something else that may prevent Alzheimer's.
Investigators have looked at different vitamins in
the food we eat to see if any help prevent the
onset of Alzheimer's. There is some suggestion
that vitamin E may have a preventative role.
Recently a study out of the Rush Institute for
Healthy Aging and the Rush Presbyterian-St Luke's
Medical Center, both in Chicago, Illinois looked
at the B vitamins to see if either dietary levels
or vitamin supplements were associated with any
decrease in the development of Alzheimer's.
They found that individuals who consumed the
highest levels of vitamin B3 (niacin) (over 22 mg
a day) were almost 80% less likely to be diagnosed
with Alzheimer’s in the succeeding 4 years than
those who took in less than 13 mg of niacin per
day (approximately the current recommended daily
allowance).The intake amount of the other B
vitamins did not seem to show any relationship to
an Alzheimer's diagnosis.
Foods such as chicken, nuts, beans and peas and
enriched grains and rice and wheat bran cereals
are high in vitamin B3.
Vitamin B3 and Alzheimer's disease
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Serzone(R) warning
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have just learned that the antidepressant
Serzone which I have taken for the past five
years has been "black labeled" by the FDA. What
does this mean, and why is the drug still on the
market?" - MAC
The term which is being used is a "black box
warning" which is required by the U.S. Food and
Drug Association (FDA) where a major side effect
problem has been identified with a pharmaceutical
product. This is a method of drawing specific
problems to the attention of physicians and is
designed to help them prescribe products
appropriately.
In effect, the FDA required the manufacturer, in
this case Bristol-Myers Squibb Co., in in December
2001 to put words inside a heavy black box that
warns about the chance of fatal liver failure that
has been reported with the use of Serzone.
Nefazodone is the generic name for this
SSRI/tricyclic antidepressant. The warning appears
in the drug insert that comes with the medicine,
in any advertising of the medicine and in the
Physician's Desk Reference (PDR) that doctors use
to look up the dose and side effects.
The chance of liver failure is rare. The reported
rate in the United States is about 1 case of liver
failure resulting in death or need for liver
transplant per 250,000 - 300,000 patient-years of
Serzone (R) treatment. In other words, for each
25,000 individuals taking the drug for 10 years,
there was one case of liver failure. Symptoms of
liver failure include jaundice (yellowing of the
skin), extreme loss of appetite, stomach and bowel
complaints and severe tiredness.
You ask why the drug has not been withdrawn from
the market? I would guess it was because the
incidence of severe problems is very low and the
medicine has much greater benefit than harm.
Additionally, there are many medicines on the
market today that have rare but very serious or
deadly side effects. If the FDA required all of
them to be withdrawn from the market, there would
not be many prescription medicines left standing.
Even Tylenol(R) would not make the cut.
The best action you can take right now is to see
your physician who placed you on Serzone and ask
if you can have blood chemistries performed to
check for any elevated liver function enzymes. If
they are normal, you will then have to decide if
you wish to stay on the drug or be switched to
another. Be careful though; they all have rare
reactions that can be serious. It is best to try
to discontinue all of the medicines you can,
otherwise there is always the risk of a serious
reaction to them.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Gingivitis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Inflammation of the mouth gum tissue is very
common and as many as 80% of individuals have some
degree of gum infection. Bacteria in the mouth and
minerals in the saliva form dental calculus
between the teeth and gums. This scaly mineral
deposit that the dental hygienist chips off when
you have your teeth cleaned provides a site for
additional bacteria. These bacteria cause further
gum inflammation.
If infection stays too long between the teeth and
gums, eventually the bone of the jaw that holds in
teeth can also become infected. Bone infection is
very difficult to cure with antibiotics once it
gets going. Eventually the bone infection,
periodontitis, causes the teeth to loosen and
eventually fall out.
Repetitive bleeding of the gums when you brush
your teeth is a sign of gingivitis. Sometimes the
gums become swollen and tender but not very
painful. Regular brushing of the teeth and dental
flossing is the way to prevent gingivitis but a
visit to the dentist for regular teeth cleaning
also helps make up for those times when we forget.
Certain conditions predispose to gingivitis:
any medicines that decrease saliva production
diabetes
smoking
pregnancy
decreased immunity
genetic predisposition
To keep your gums healthy, Mayo Clinic offers the
following suggestions:
Choose the right toothbrush
Use fluoride toothpaste
Brush twice daily
Angle your toothbrush to 45 degrees to get under
the gums
Floss daily
And don't forget the regular visits to the dentist.
Gingivitis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Heartburn
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
You should seek medical advice when:
heartburn occurs several times a week
heartburn wakes you up at night on a recurrent
basis
heartburn comes back shortly after using an
antacid
FRJ
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Thoughts on aging
Eventually you will reach a point when you stop
lying about your age and start bragging about it.
The older we get, the fewer things seem worth
waiting in line for.
Some people try to turn back their odometers. Not
me, I want people to know "why" I look this way.
I've traveled a long way and some of the roads
weren't paved.
How old would you be if you didn't know how old
you are?
When you are dissatisfied and would like to go
back to youth, think of Algebra.
You know you are getting old when everything
either dries up or leaks.
One of the many things no one tells you about
aging is that it is such a nice change from being
young.
One must wait until evening to see how splendid
the day has been.
Ah, being young is beautiful, but being old is
comfortable.
Old age is when former classmates are so gray, so
wrinkled, and so bald they don't recognize you.
If you don't learn to laugh at trouble, you won't
have anything to laugh at when you are old.
And best of all--
I don't know how I got over the hill without
getting to the top.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Health Newsletter *******
January 12, 2003
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Is female sexual dysfunction a new disease?
2. Age bumps and melanoma skin cancer
3. Reader submitted Q&A - Arthritis flare after HRT
4. Heart disease knows no gender
5. Health tip to share - Ice cream headache
6. Humor is healthy
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Is female sexual dysfunction a new disease?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
An interesting (and bound to be very
controversial) article about defining the entity
of female sexual dysfunction has recently appeared
in the British Medical Journal. In it, the author
essentially accuses the pharmaceutical industry of
sponsoring the definition of female sexual
dysfunction so that they can conduct clinical
trials that might show their drug sildenafil
(Viagra) to have a place in treating women just as
it does in treating men who have "erectile
dysfunction". The author states that "a cohort of
researchers with close ties to drug companies are
working with colleagues in the pharmaceutical
industry to develop and define a new category of
human illness at meetings heavily sponsored by
companies racing to develop new drugs."
Since this main drug, sildenafil, accounts for
over 1.5 billion dollars in sales, we have to take
this concern seriously, i.e., that they are trying
to create a medical market for which they have a
drug. On the other hand, maybe this is an area
which has been overlooked by physicians as
something that they should be identifying and
offering treatment for.
As best I can tell about the development the
author makes reference to, a consensus panel (with
pharmaceutical ties) divided female sexual
dysfunction into four categories of disorders:
sexual desire disorders (libido)
sexual arousal disorders
orgasmic disorders
sexual pain disorders
The purpose was to identify arousal in the female
as a problem separate from the lack of desire or
interest in having sex. It is this area that the
pharmaceutical companies were interested in to see
if a drug like sildenafil could play a role. In
other words, this would target women who say it
isn't that they do not have any desire to have
sex, but rather they just have major difficulty
becoming sexually aroused even with an adequate
stimulus.
Once this category of "medical problem" was
defined, clinical studies could be conducted to
see if drug treatment could play a role in
reducing the problem. Of three studies that have
been conducted in women with "arousal disorder"
that I could find, two have shown no benefit from
sildenafil and one showed only a slight benefit.
Thus there is still a question as to whether there
is a separate disorder in women of "arousal
problems" versus "desire" problems as there is in
men. The article itself is worth reading but more
fascinating are the comments by readers that
follow the article as to whether this is just a
contrived problem for financial benefit on the
part of pharmaceutical companies or an overlooked
problem that needs medical attention.
What do you think?
The making of a disease: female sexual dysfunction
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Age bumps and melanoma skin cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Seborrheic keratoses (age bumps) are elevated skin
lesions that come with age. They may appear as
large freckles that are scaly, raised and often
darkened (pigmented) more than a normal freckle so
that they can be hard to differentiate from a
melanoma skin cancer. As one gets older, they can
appear frequently all over the body.
This presents a problem if one has many seborrheic
keratoses to be excised from the skin. Should
every one be sent to pathology to make sure they
are not really a malignant melanoma skin cancer?
The following study in the Archives of Dermatology
looks at how often skin lesions that are thought
to be seborrheic keratoses turn out to be
melanomas.
The investigators looked at over 9000 consecutive
pathology reports containing a diagnosis of
seborrheic keratosis in the clinical information
provided with the biopsy. We do not know how many
lesions were removed so the 9000 represents a
subset of seborrheic keratoses treated by those
physicians. Among all of the biopsied lesions,
less than one percent (0.66%) were identified as
melanoma.
While this is not a high number, it is a real
possibility, so the authors recommend the practice
of submitting all biopsies to continue. However,
it is important for you to know that these lesions
rarely turn out to be malignant.
Age bumps and melanoma skin cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Arthritis flare after HRT
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Is it normal to have significant joint soreness
after quitting H.R.T.? My Dr. took me off about 4
months ago and I now feel 10 years older as far as
stiffness and joints are concerned."
"I am 63 years old and took H.R.T. for 8 years. I
take a mild med for high blood pressure and
average meds for thyroid. I went off H.R.T. all at
once and have since heard that others tapered off
gradually."
"I have not been back to my Dr. as I am in the
middle of changing insurance companies again.
I've checked with many pharmacists and none of
them have heard of this problem." - RUE
What you describe is not common, but physicians
hear this frequently as far as joint and muscle
pain flare up upon discontinuing hormone
replacement therapy (HRT) or estrogen replacement
therapy (ERT). With either arthritis or muscle
conditions, the relationship of hormone therapy is
somewhat complex.
Osteoarthritis in humans does not seem to benefit
at all from HRT/ERT even though there is evidence
in animals that it may play a protective role.
Osteoarthritis, and thus its joint pain, should
not worsen with HRT withdrawal.
Rheumatoid arthritis sometimes benefits from
HRT/ERT especially if there is an overall calcium
loss. Any arthritis associated with cortisone-like
therapy (glucocorticoids) especially is helped
because the estrogens in HRT/ERT help prevent bone
loss which worsens the joint pain.
An excessive rate of bone loss, osteoporosis, can
be superimposed upon any type of arthritis, even
osteoarthritis. Therefore going off the HRT could
make joint pain worse if there is an osteoporosis
component going on.
I would suggest asking your doctor to order a bone
density scan to see if your total body bone
mineral density is low. If so, you can take non-
hormonal medicines such as raloxifene (Evista®) or
bisphosphonates (Fosamax®,Actonel®, Didronel®).
You should be taking calcium supplementation at
least 1500 mg a day and a preventative like
raloxifene whether or not your total bone mineral
density is low.
Finally, make sure your doctor is evaluating you
for what type of arthritis you might have or refer
you to a hematologist for diagnosis and
consultation. IF you have an early rheumatoid or
osteoarthritis, diagnosing it at this stage may
help you slow the progression of joint
inflammation down.
A last alternative is to consider resuming the
HRT. The benefits (decreased joint pain) may
outweigh the risks (about a 1% increase in breast
cancer) of taking it.
I have not heard of any advantage of tapering HRT
but I doubt it would be harmful and perhaps it
would allow the body to accomodate to withdrawal
easier.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Heart disease knows no gender
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Heart disease is the number one cause of death for
women. I suspect most of our readers know that but
across the country, many women have other concepts
as to what they are at the most risk for. In order
to delay that time of a fatal heart attack,
exercise and diet are the best prevention
strategies. The following suggestions from
Personal MD.com may help remind us to keep our
health resolve:
1. Buy the deepest color of ground beef you can
find. The darker the red, the less fat it
contains.
2. Do your own yard work. Mow your lawn. Rake the
leaves or grass. It's great exercise for your
arms.
3. When eating at a restaurant, split an entree.
Portions at restaurants tend to be large. Before
eating a pizza, blot up the oil with a napkin.
4. Take the stairs whenever you can. Each flight
burns 10 calories and keeps your thigh muscles
toned.
5. Don't use creamy dressings or croutons on your
salad. If you must have something crunchy on it,
walnuts can be a good alternative because they are
high in omega-3 fatty acids.
6. When talking on the cordless phone, stretch
your arms and legs or do arm curls with a can of
food in your hand.
7. Keep high-calorie, high-fat foods out of sight
in your pantry. Put raw vegetables and fruits in
the front of the refrigerator so you see them
first.
8. Play with your children or pet. Play chase with
the dog or take him for a walk. Take the kids to a
park for a game of tag or push them on the swings.
Badminton, volleyball and swimming are fun things
you can do together.
9. Eat crunchy, healthy snacks such as carrots,
celery or rice cakes instead of chips, cookies and
soda.
10. Walk as much as you can. Park you car at the
far end of the lot, and walk to the grocery store
or the dry cleaners. When you take your kids to
soccer practice, spend the time walking around the
field while your kids play.
Heart disease knows no gender
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Ice cream headache
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Ice cream headache refers to a short duration
headache when eating a cold substance like ice
cream. It occurs when very cold food or drink
touches and stimulates the roof of the mouth. Over
80% of individuals have experienced this at
sometime in their lives.
Eating cold food slowly, e.g., ingesting a small
scoop of ice cream over a minute or more versus
eating it in 5-10 seconds, will reduce the chance
of a headache by 50%. But even eating it slowly
can produce a headache in 10% or more of
individuals. FRJ
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"New Year's Resolutions for Internet Junkies"
1. I will try to figure out why I *really* need 9
e-mail addresses.
2. I will stop sending e-mail to my husband.
3. I resolve to work with neglected children --
my own.
4. I will answer my snail mail with the same
enthusiasm with which I answer my e-mail.
5. I will stop sending e-mail, ICQ, Instant
Messages and be on the phone at the same time with
the same person.
6. I resolve to back up my 12GB hard drive daily...
well, once a week...
okay, monthly then...
or maybe...
7. I will spend less than one hour a day on the
Internet. This, of course, will be hard to
estimate since I'm not a clock watcher.
8. When I hear "Where do you want to go today?"
I will not reply "MS Tech Support."
9. When I hear a funny joke I will not reply,
"LOL... LOL!"
10. I will read the manual... just as soon as I
can find it.
11. I will think of a password other than
"password."
12. I will stop checking my e-mail at 3:00 in the
morning...
4:30 is much more practical.
13. I resolve... I resolve to... I resolve to,
uh... I resolve to, uh, get my, er... I resolve
to, uh, get my, er, off-line work done, too!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Health Newsletter *******
January 26, 2003
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Dandruff
2. Night time heartburn and sleep apnea
3. Reader submitted Q&A - Steroids and osteopenia
4. Pap smear interval and cancer of cervix
5. Health tip to share - Yoga for health
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Dandruff
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dandruff is a minor health problem that many
adults have. It is characterized by flaking skin
and itching of the scalp. It is more embarassing
than a serious medical concern, but those who have
it don't want it. Fortunately most of the time
dandruff can be controlled.
Actually there are several conditions that can
result in itchy, flaky skin of the scalp:
dry skin - especially in the winter months, small,
non waxy flakes
seborrheic dermatitis (classic dandruff) -
reddened oily flaky skin with white or yellow
scales. often involves eyebrows, back of ears,
side of nose, armpits and groins.
psoriasis - silvery scales often with skin
cracking and bleeding. Involves also elbows,
knees, forehead and trunk
scalp ringworm (tinea capitis) - the only
contagious cause of dandruff causes red, inflamed
scalp as well as hair loss
contact dermatitis - scalp skin sensitivity to
hair products, dyes
The cause of most dandruff (seborrheic dermatosis)
is thought to be a yeast-like fungus, malassezia,
previously called pityrosporum. It is present on
most adult scalps but sometimes grows out of
control feeding on hair follicle oil. It causes
skin irritation which leads to flaking.
If you try over-the-counter products and they do
not seem to work, you may want to see a
dermatologist. they will probably suggest other
shampoo treatments varying by the active
ingredient in the shampoo. The active ingredient
may be zinc pyrithione (Suave Dandruff Control
Shampoo, Head & Shoulders), tar-based shampoos
(Ala Seb-T, Neutrogena T/Gel, Tegrin), salicylic
acid (Ala Seb, Ionil T), selenium sulfide (Selsun,
Exsel), and ketoconazole (Nizoral).
Sometimes you have to just try different types of
shampoos to see what one works the best. It may be
necessary to alternate shampoos or switch types if
one loses its effectiveness. Be sure to let the
shampoo stay on for at least 5 minutes to get an
adequate dose of the active ingredient to the
skin.
Dandruff
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Night time heartburn and sleep apnea
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gastroesophageal reflux disease (GERD), better
known as heartburn, affects many individuals.
Investigators have recently found out that
individuals with sleep apnea who have heartburn at
night, show significant reduction of symptoms when
they are properly treated for the apnea.
The treatment for sleep apnea is usually CPAP or
continuous, positive airway pressure. It is a
breathing machine attached to a face mask that the
person wears at night and it generates a slight
inflow of air that presumably causes increased
pressure in the respiratory cavity. The increased
pressure must keep down reflux because symptoms of
heartburn are reduced by almost 50% when the CPAP
treatment is used.
I would like to suggest that we consider turning
this finding around and ask if symptoms of
heartburn are present at night, could that mean a
person is more likely to have sleep apnea? The
study below did NOT address that possibility but I
think that it and other articles offer indirect
evidence that should make us consider this
possibility.
Thus I would recommend to you that if you
currently have heartburn that frequently bothers
you at night, ask your physician to consider
ordering a sleep study for you to see if sleep
apnea is a major cause of that heartburn. If it
is, then treating the sleep apnea is a much better
strategy than just taking oral heartburn medicine
because there are many other health problems (eg.
tiredness, fatigue) that would be helped along
with the heartburn if an accurate diagnosis is
made.
Night time heartburn and sleep apnea